ABSTRACT
Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.
ABSTRACT
ABSTRACT Objective To evaluate the effectiveness of prophylactic, non-invasive ventilation (NIV) on respiratory function in seven- to 16-year-old children in the post-operative phase of cardiac surgery. Method A randomized, controlled trial with 50 children who had undergone cardiac surgery with median sternotomy. After extubation, patients were randomly assigned to one of two groups: control group (n=26), which received instructions regarding posture, early ambulation, and cough stimulation, and CPAP group (continuous positive airway pressure; n=24), which received the same instructions as the control group and CPAP=10 cmH20 twice daily for 30 minutes from the 1st to the 5th post-operative day (POD). As a primary outcome, lung function was evaluated before and on the 1st, 3rd, and 5th PODs with measures of respiratory rate (RR), tidal volume (TV), slow vital capacity (SVC), inspiratory capacity (IC), minute volume (MV), peak expiratory flow (PEF), and maximal inspiratory pressure (MIP). As secondary outcomes, the time of hospitalization and intensive care were recorded. A mixed, linear regression model and z-test were used to analyze respiratory function, considering p<0.05. Results All variables, except RR and MV, showed a significant drop on the 1st POD, with gradual recovery; however, only MIP had returned to pre-operative values on the 5th POD in both groups. The RR showed a significant increase on the 1st POD, with a gradual reduction but without returning to baseline. In the intergroup analysis, significant improvement (p=0.04) was observed only in PEF in the CPAP group on the 1st DPO. The length of hospitalization and intensive care showed no significant differences. Conclusion NIV was safe and well accepted in this group of patients, and the protocol used was effective in improving PEF on the 1st DPO in the CPAP group.
ABSTRACT
The aim of this work was to describe the morphology of seedlings and saplings of Pachyrhizus ahipa, a cultivated species of Phaseoleae (Fabaceae), analysing the seedling type and characterizing the structure of cotyledons, eophylls and metaphylls. It was observed that the seedling was semi-hypogeal, a germination type not yet recorded for the Phaseoleae tribe. It formed two opposite and unifoliated eophylls with an evident pair of stipels. Metaphylls were trifoliolate and had alternate phyllotaxis. Both eophylls and metaphylls were pinnate, camptodromous, and brochidodromous.
É de conhecimento geral que existe grande escassez de estudos referentes às fases juvenis das plantas, importantes como subsídio para diversos trabalhos ecológicos, taxonômicos e filogenéticos. Com base nesse pressuposto, descreveram-se morfologicamente plântulas e plantas jovens de Pachyrhizus ahipa, espécie cultivada de Phaseoleae (Fabaceae), analisando-se o tipo de plântula e caracterizando estruturalmente os cotilédones, eofilos e metafilos. Verificou-se que a plântula é semi-hipógea, tipo de germinação até então não registrado para a tribo Phaseoleae. A plântula forma dois eofilos unifoliolados e opostos, acompanhados por evidente par de estipelas. Os metafilos são trifoliolados, de filotaxia alterna. Tanto eofilos quanto metafilos são pinados, camptódromos e broquidódromos.